Robotic surgical devices, systems and related methods

ABSTRACT

The various inventions relate to robotic surgical devices, consoles for operating such surgical devices, operating theaters in which the various devices can be used, insertion systems for inserting and using the surgical devices, and related methods.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims priority as a continuation application to U.S.patent application Ser. No. 16/926,025, filed Jul. 10, 2020, andentitled “Robotic Surgical Devices, Systems, and Related Methods,” whichclaims priority as a continuation application to U.S. patent applicationSer. No. 15/599,231, filed May 18, 2017, and entitled “Robotic SurgicalDevices, Systems, and Related Methods,” which issued as U.S. Pat. No.10,751,136 on Aug. 25, 2020, which claims the benefit under 35 U.S.C. §119(e) to U.S. Provisional Application No. 62/338,375, filed on May 18,2016 and entitled “Robotic Surgical Devices, Systems and RelatedMethods,” all of which are hereby incorporated herein by reference intheir entireties.

TECHNICAL FIELD

The embodiments disclosed herein relate to various medical devices andrelated components, including robotic and/or in vivo medical devices andrelated components. Certain embodiments include various robotic medicaldevices, including robotic devices that are disposed within a bodycavity and positioned using a support component disposed through anorifice or opening in the body cavity. Further embodiments relate tomethods and devices for operating the above devices.

BACKGROUND

Invasive surgical procedures are essential for addressing variousmedical conditions. When possible, minimally invasive procedures such aslaparoscopy are preferred.

However, known minimally invasive technologies such as laparoscopy arelimited in scope and complexity due in part to 1) mobility restrictionsresulting from using rigid tools inserted through access ports, and 2)limited visual feedback. Known robotic systems such as the da Vinci®Surgical System (available from Intuitive Surgical, Inc., located inSunnyvale, CA) are also restricted by the access ports, as well ashaving the additional disadvantages of being very large, very expensive,unavailable in most hospitals, and having limited sensory and mobilitycapabilities.

There is a need in the art for improved surgical methods, systems, anddevices.

BRIEF SUMMARY OF THE INVENTION

Discussed herein are various robotic surgical systems, including certainsystems having camera lumens configured to receive various camerasystems. Further embodiments relate to surgical insertion devicesconfigured to be used to insert various surgical devices into a cavityof a patient while maintaining insufflations of the cavity.

In one Example, a robotic surgical system, including: a robotic surgicaldevice including: a device body including front and back sides and adistal end and a proximal end; first and second shoulder joints operablycoupled to the distal end of the device body; a first robotic armoperably coupled to the first shoulder joint; and a second robotic armoperably coupled to the second shoulder joint; and a camera component,including a flexible section and a distal imager, where the first andsecond robotic arms are constructed and arranged so as to be positionedon the front or back sides of the body.

Implementations may include one or more of the following features. Therobotic surgical system where the surgical device includes at least oneactuator. The robotic surgical system where the first and second roboticarms include at least one motor disposed within each of the first andsecond robotic arms. The robotic surgical system further including asupport device configured to remote center the robotic surgical device.The robotic surgical system further including an surgical console. Therobotic surgical system where the camera is disposed through a lumendefined in the robotic surgical device. The robotic surgical systemwhere the camera is configured to be an adjustable height camera. Therobotic surgical system where the camera is constructed and arranged tobe capable of pitch and yaw. The robotic surgical system where thedistal camera tip is configured to orient to a define workspace. Therobotic surgical system where the camera includes lights. The roboticsurgical system where the robotic surgical device further includes firstand second end effectors. The robotic surgical system where the firstrobotic arm further includes an upper arm and a forearm. The roboticsurgical system where the first robotic arm further includes: a firstarm upper arm; a first arm elbow joint; and a first arm lower arm, wherethe first arm upper arm is configured to be capable of roll, pitch andyaw relative to the first shoulder joint and the first arm lower arm isconfigured to be capable of yaw relative to the first arm upper arm byway of the first arm elbow joint. The surgical robotic system where thefirst robotic arm further includes at least one first arm actuatordisposed within the first robotic arm. The robotic surgical system wherethe second robotic arm further includes: a second arm upper arm; \asecond arm elbow joint; and a second arm lower arm, where the second armupper arm is configured to be capable of roll, pitch and yaw relative tothe second shoulder joint and the second arm lower arm is configured tobe capable of yaw relative to the second arm upper arm by way of thesecond arm elbow joint. The surgical robotic system where the secondrobotic arm further includes at least one second arm actuator disposedwithin the second robotic arm. The surgical robotic system where thefirst and second arms include at least one motor disposed in each arm.The surgical robotic system further including at least one PCB disposedwithin at least one of the first or second robotic arms and inoperational communication with at least one of the first robotic arm andsecond robotic arm, where the PCB is configured to perform yaw and pitchfunctions.

One Example includes A robotic surgical system, including: a roboticsurgical device including: a device body including: a distal end; aproximal end; a front side; and a back side; first and second shoulderjoints operably coupled to the distal end of the device body; a firstrobotic arm operably coupled to the first shoulder joint; and a secondrobotic arm operably coupled to the second shoulder joint; and a cameracomponent, including: a shaft; an imager; and a flexible sectionoperably coupling the imager to the shaft, where the first and secondrobotic arms are constructed and arranged so as to be positioned on thefront or back sides of the body. Implementations may include one or moreof the following features. The robotic surgical system where the firstrobotic arm further includes an upper arm and a forearm. The roboticsurgical system where the first robotic arm further includes: a firstarm upper arm; a first arm elbow joint; and a first arm lower arm, wherethe first arm upper arm is configured to be capable of roll, pitch andyaw relative to the first shoulder joint and the first arm lower arm isconfigured to be capable of yaw relative to the first arm upper arm byway of the first arm elbow joint. The surgical robotic system where thefirst robotic arm further includes at least one first arm actuatordisposed within the first robotic arm. The robotic surgical system wherethe second robotic arm further includes: a second arm upper arm; asecond arm elbow joint; and a second arm lower arm, where the second armupper arm is configured to be capable of roll, pitch and yaw relative tothe second shoulder joint and the second arm lower arm is configured tobe capable of yaw relative to the second arm upper arm by way of thesecond arm elbow joint. The surgical robotic system where the secondrobotic arm further includes at least one second arm actuator disposedwithin the second robotic arm. The surgical robotic system where thefirst and second arms include at least one motor disposed in each arm.The surgical robotic system further including at least one PCB disposedwithin at least one of the first or second robotic arms and inoperational communication with at least one of the first robotic arm andsecond robotic arm, where the PCB is configured to perform yaw and pitchfunctions. Implementations of the described techniques may includehardware, a method or process, or computer software on acomputer-accessible medium.

Another Example includes A robotic surgical system, including: a roboticsurgical device including: a device body including: a distal end; aproximal end, and a camera lumen defined within the device body, thecamera lumen including: a proximal lumen opening in the proximal end ofthe device body; a socket portion defined distally of the proximal lumenopening, the socket portion including a first diameter and a firstcoupling component; an extended portion defined distally of the socketportion, the extended portion having a second, smaller diameter; and adistal lumen opening in the distal end of the device body, the distallumen opening defined at a distal end of the extended portion; first andsecond shoulder joints operably coupled to the distal end of the devicebody; a first robotic arm operably coupled to the first shoulder joint;and a second robotic arm operably coupled to the second shoulder joint;and a camera component, including an elongate tube operably coupled tothe handle, where the elongate tube is configured and sized to bepositionable through the extended portion, the elongate tube including:a shaft; an imager; and a flexible section operably coupling the opticalsection to the rigid section, where the elongate tube has a length suchthat at least the optical section is configured to extend distally fromthe distal lumen opening when the camera component is positioned throughthe camera lumen.

Implementations may include one or more of the following features. Thesurgical robotic system where the first and second arms include at leastone motor disposed in each arm. The surgical robotic system furtherincluding at least one PCB disposed within at least one of the first orsecond robotic arms and in operational communication with at least oneof the first robotic arm and second robotic arm, where the PCB isconfigured to perform yaw and pitch functions.

While multiple embodiments are disclosed, still other embodiments of thepresent invention will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the invention. As will be realized, theinvention is capable of modifications in various obvious aspects, allwithout departing from the spirit and scope of the present invention.Accordingly, the drawings and detailed description are to be regarded asillustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a front view of a surgical device, according to oneembodiment.

FIG. 1B is a front view of the device of FIG. 1A inserted into the bodycavity.

FIG. 2 is a front view of a surgical device, according to oneembodiment.

FIG. 3 is a three-quarters perspective view of the robot of theimplementation of FIG. 2 without the camera.

FIG. 4 is a three-quarters perspective view of the camera of theimplementation of FIG. 2 without the robot.

FIG. 5A is a close-up perspective view of a surgical device, accordingto one embodiment.

FIG. 5B is front view of the embodiment of FIG. 5A, wherein the arms andcamera are in the “insertion” position.

FIG. 6A is a perspective view of a surgical device showing variousworkspaces for the arms, according to one embodiment.

FIG. 6B is a further perspective view of the surgical device of FIG. 6A,showing the workspace of one arm.

FIG. 7A is a side view of the robot according to one embodiment, showingthe range of motion of the arms and the associated workspaces, accordingto one embodiment.

FIG. 7B is a top view of the implementation of FIG. 7A, showing therange of motion of the arms and the associated workspaces.

FIG. 7C is a perspective view of the implementation of FIG. 7A, showingthe range of motion of the arms and the associated workspaces.

FIG. 8A is a rear perspective view of one implementation of a surgicaldevice, showing the positioning of the arms to the ahead and behind thedevice, according to one embodiment.

FIG. 8B is a three-quarters rear view of the device of FIG. 8A, showingseveral possible arm positions.

FIG. 8C is a lower perspective front view of the device showing the armpositions of FIG. 8B.

FIG. 9 is a perspective view of a surgical device according to oneembodiment showing the camera and arms oriented in a central “down” workposition.

FIG. 10 is a front view of the device of FIG. 9 showing the arms in ancentral “up” position.

FIG. 11 is a perspective view of a surgical device according to oneembodiment showing the arms in a “down” position.

FIG. 12A is a top view of a surgical device, according to oneimplementation.

FIG. 12B is a top view of a surgical device, according to anotherimplementation.

FIG. 12C is a front view of a surgical device, according to oneimplementation.

FIG. 12D is a front view of a surgical device, according to anotherimplementation.

FIG. 12E is a side view of a surgical device, according to oneimplementation.

FIG. 12F is a side view of a surgical device, according to anotherimplementation.

FIG. 13A is a perspective view of a surgical device according to oneembodiment, showing the movement of the first joint.

FIG. 13B is a perspective view of a surgical device according to oneembodiment, showing the movement of the second joint.

FIG. 13C is a perspective view of a surgical device according to oneembodiment, showing the movement of the third joint.

FIG. 13D is a perspective view of a surgical device according to oneembodiment, showing the movement of the fourth joint.

FIG. 14 is a perspective view of a surgical robotic device showing theinternal components, according to one implementation.

FIG. 15 is a front view showing the internal components of the body andshoulders, according to one embodiment.

FIG. 16 is a perspective view showing the internal components of thebody, according to one embodiment

FIG. 17 is a perspective view showing the internal components of theshoulders, according to one embodiment.

FIG. 18 is a side view showing the internal components of the shoulders,according to one embodiment.

FIG. 19 is a reverse perspective view showing the internal components ofthe body and shoulders, according to one embodiment.

FIG. 20 is a perspective view showing the internal components of theupper arm, according to one embodiment.

FIG. 21 is a perspective view showing further internal components of theupper arm, according to one embodiment.

FIG. 22 is a front view showing further internal components of the upperarm, according to one embodiment.

FIG. 23 is a perspective view showing further internal components of theupper arm, according to one embodiment.

FIG. 24 is a perspective view showing internal components of the lowerarm, according to one embodiment.

FIG. 25 is a perspective view showing further internal components of theupper arm, according to one embodiment.

FIG. 26 is a perspective view showing further internal components of theupper arm, according to one embodiment.

FIG. 27 is a perspective view showing yet further internal components ofthe upper arm, according to one embodiment.

FIG. 28A is a front perspective view of a surgical device having anarticulating camera, according to one embodiment.

FIG. 28B is a close-up perspective view of the camera of FIG. 28Ashowing a variety of possible movements.

FIG. 28C is a front view of a robotic device and camera havingadjustable depth, according to one embodiment.

FIG. 28D is a close up view of the device lumen and camera shaft showingthe adjustable depth mechanism, according to one implementation, showingthe camera in an “up” position.

FIG. 28E is a front view of the robot and camera, according to theimplementations of FIGS. 28C and 28D.

FIG. 28F is a front view of a robotic device and camera havingadjustable depth, according to one embodiment.

FIG. 28G is a close up view of the device lumen and camera shaft showingthe adjustable depth mechanism, according to one implementation, showingthe camera in an “down” position.

FIG. 28H is a front view of the robot and camera, according to theimplementations of FIGS. 28F and 28G.

FIG. 28I is a cross-sectional view of the body lumen, according to oneembodiment.

FIG. 29A depicts a surgical device workspace and field of view,according to exemplary implementation.

FIG. 29B depicts a surgical device workspace and field of view,according to another exemplary implementation.

FIG. 30A depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 30B depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 30C depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 30D depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 30E depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 30F depicts a surgical device and zero-degree camera in one of arange of possible positions, according to one implementation.

FIG. 31A depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 31B depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 31C depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 31D depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 31E depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 31F depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32A depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32B depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32C depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32D depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32E depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 32F depicts a surgical device and zero-degree camera in one of arange of possible positions, according to another implementation.

FIG. 33A depicts a surgical device and camera in a first viewingposition with an “S-scope” configuration, according to oneimplementation.

FIG. 33B depicts a surgical device and camera in a second viewingposition with an “S-scope” configuration, according to oneimplementation.

FIG. 33C depicts a surgical device and camera in a first viewingposition with an “S-scope” configuration, according to oneimplementation.

FIG. 34A is one implementation of the articulating camera tip.

FIG. 34B is another implementation of the articulating camera tip.

FIG. 34C is yet another implementation of the articulating camera tip.

FIG. 35A is a side view of the surgical device and camera showing thecamera between at a first depth, according to one embodiment.

FIG. 35B is a side view of the surgical device and camera showing thecamera between at a second depth, according to one embodiment.

FIG. 35C is a side view of the surgical device and camera showing thecamera between at a third depth, according to one embodiment.

FIG. 36A is a side view of a surgical device end effector, according toone embodiment.

FIG. 36B is a side view of a surgical device end effector, according toanother embodiment.

FIG. 36C is a side view of a surgical device end effector, according toanother embodiment.

FIG. 37 is a front view of the surgical device on a support structure,according to one implementation.

FIG. 38 is a perspective view of the surgical device on a supportstructure, according to one implementation.

FIG. 39 is a cross-sectional view of the surgical device at theinsertion point, according to one implementation.

FIG. 40A is a perspective view of the surgical device on a supportstructure, according to one implementation.

FIG. 40B is a side view of the surgical device on a support structure,according to one implementation.

FIG. 41A is a perspective view of the surgical device on a supportstructure, according to one implementation.

FIG. 41B is a further perspective view of the surgical device on asupport structure, according to the implementation of FIG. 41A.

FIG. 42A is a perspective view of the surgical device on another supportstructure, according to one implementation.

FIG. 42B is a further perspective view of the surgical device on asupport structure, according to the implementation of FIG. 42A.

FIG. 42C is yet a further perspective view of the surgical device on asupport structure, according to the implementation of FIG. 42A.

FIG. 43 is a side view of the surgical device on yet another supportstructure, according to one implementation.

FIG. 44 is yet a further perspective view of the surgical device on asupport structure, according to another implementation.

FIG. 45 is a perspective view of the surgical device on a support robot,according to another implementation.

FIG. 46 is a perspective view of the surgical device on a support robot,according to another implementation.

FIG. 47 is a perspective view of the surgical device on a ball jointsupport structure, according to another implementation.

FIG. 48A is a perspective view of a support structure for positioningthe surgical device, according to one implementation.

FIG. 48B-1 is a side view of the support device according to theembodiment of FIG. 48 in a first position.

FIG. 48B-2 is a top view of the implementation of the support device ofFIG. 48B-1 .

FIG. 48C-1 is a side view of the support device according to theembodiment of FIG. 48 in a second position.

FIG. 48C-2 is a top view of the implementation of the support device ofFIG. 480-1 .

FIG. 48D-1 is a side view of the support device according to theembodiment of FIG. 48 in a third position.

FIG. 48D-2 is a top view of the implementation of the support device ofFIG. 48D-1

FIG. 49 is a perspective view of a support structure positioning thesurgical device, according to one implementation.

FIG. 50A is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 50B is a side view of another support structure positioning thesurgical device, according to one implementation.

FIG. 50C is a side view of another support structure positioning thesurgical device, according to one implementation.

FIG. 50D is a side view of another support structure positioning thesurgical device, according to one implementation.

FIG. 51 is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 52A is a side view of another support structure positioning thesurgical device, according to one implementation.

FIG. 52B is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 52C is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 52D is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 52E is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 52F is a perspective view of another support structure positioningthe surgical device, according to one implementation.

FIG. 53 is a perspective view of the surgical console, according to oneimplementation.

FIG. 54 is a schematic view of a surgical system, according to oneimplementation.

FIG. 55 is another schematic view of a surgical system, according to oneimplementation.

DETAILED DESCRIPTION

The various systems and devices disclosed herein relate to devices foruse in medical procedures and systems. More specifically, variousembodiments relate to various medical devices, including robotic devicesand related methods and systems.

It is understood that the various embodiments of robotic devices andrelated methods and systems disclosed herein can be incorporated into orused with any other known medical devices, systems, and methods.

It is understood that the various embodiments of robotic devices andrelated methods and systems disclosed herein can be incorporated into orused with any other known medical devices, systems, and methods. Forexample, the various embodiments disclosed herein may be incorporatedinto or used with any of the medical devices and systems disclosed incopending U.S. application Ser. No. 11/766,683 (filed on Jun. 21, 2007and entitled “Magnetically Coupleable Robotic Devices and RelatedMethods”), Ser. No. 11/766,720 (filed on Jun. 21, 2007 and entitled“Magnetically Coupleable Surgical Robotic Devices and Related Methods”),Ser. No. 11/966,741 (filed on Dec. 28, 2007 and entitled “Methods,Systems, and Devices for Surgical Visualization and DeviceManipulation”), 61/030,588 (filed on Feb. 22, 2008), Ser. No. 12/171,413(filed on Jul. 11, 2008 and entitled “Methods and Systems of Actuationin Robotic Devices”), Ser. No. 12/192,663 (filed Aug. 15, 2008 andentitled Medical Inflation, Attachment, and Delivery Devices and RelatedMethods”), Ser. No. 12/192,779 (filed on Aug. 15, 2008 and entitled“Modular and Cooperative Medical Devices and Related Systems andMethods”), Ser. No. 12/324,364 (filed Nov. 26, 2008 and entitled“Multifunctional Operational Component for Robotic Devices”), 61/640,879(filed on May 1, 2012), Ser. No. 13/493,725 (filed Jun. 11, 2012 andentitled “Methods, Systems, and Devices Relating to Surgical EndEffectors”), Ser. No. 13/546,831 (filed Jul. 11, 2012 and entitled“Robotic Surgical Devices, Systems, and Related Methods”), 61/680,809(filed Aug. 8, 2012), Ser. No. 13/573,849 (filed Oct. 9, 2012 andentitled “Robotic Surgical Devices, Systems, and Related Methods”), Ser.No. 13/738,706 (filed Jan. 10, 2013 and entitled “Methods, Systems, andDevices for Surgical Access and Insertion”), Ser. No. 13/833,605 (filedMar. 15, 2013 and entitled “Robotic Surgical Devices, Systems, andRelated Methods”), Ser. No. 13/839,422 (filed Mar. 15, 2013 and entitled“Single Site Robotic Devices and Related Systems and Methods”), Ser. No.13/834,792 (filed Mar. 15, 2013 and entitled “Local Control RoboticSurgical Devices and Related Methods”), Ser. No. 14/208,515 (filed Mar.13, 2014 and entitled “Methods, Systems, and Devices Relating to RoboticSurgical Devices, End Effectors, and Controllers”), Ser. No. 14/210,934(filed Mar. 14, 2014 and entitled “Methods, Systems, and DevicesRelating to Force Control Surgical Systems), Ser. No. 14/212,686 (filedMar. 14, 2014 and entitled “Robotic Surgical Devices, Systems, andRelated Methods”), and Ser. No. 14/334,383 (filed Jul. 17, 2014 andentitled “Robotic Surgical Devices, Systems, and Related Methods”), andU.S. Pat. No. 7,492,116 (filed on Oct. 31, 2007 and entitled “Robot forSurgical Applications”), U.S. Pat. No. 7,772,796 (filed on Apr. 3, 2007and entitled “Robot for Surgical Applications”), and U.S. Pat. No.8,179,073 (issued May 15, 2011, and entitled “Robotic Devices with AgentDelivery Components and Related Methods”), U.S. Published ApplicationNo. 2016/0074120 (filed Sep. 14, 2015, and entitled “Quick-Release EndEffectors and Related Systems and Methods”), U.S. Published ApplicationNo. 2016/0135898 (filed Nov. 11, 2015 entitled “Robotic Device withCompact Joint Design and Related Systems and Methods”), U.S. patentapplication Ser. No. 15/227,813 (filed Aug. 3, 2016 and entitled“Robotic Surgical Devices, Systems, and Related Methods”), U.S.Provisional Application No. 62/379,344 (filed Aug. 25, 2016 and entitled“Quick-Release End Effector Tool Interface and Related Systems andMethods”), U.S. Provisional Application No. 62/425,149 (filed Nov. 22,2016 and entitled “Improved Gross Positioning Device and Related Systemsand Methods”), U.S. Provisional Application No. 62/427,357 (filed Nov.29, 2016 and entitled “Controller with User Presence Detection andRelated Systems and Methods”), U.S. Provisional Application No.62/433,837 (filed Dec. 14, 2016 and entitled “Releasable AttachmentDevice for Coupling to Medical Devices and Related Systems andMethods”), and U.S. Provisional Application No. 62/381,299 (filed Aug.30, 2016 and entitled “Robotic Device with Compact Joint Design and anAdditional Degree of Freedom and Related Systems and Methods”) a all ofwhich are hereby incorporated herein by reference in their entireties.

Certain device and system implementations disclosed in the applicationslisted above can be positioned within a body cavity of a patient incombination with a support component similar to those disclosed herein.An “in vivo device” as used herein means any device that can bepositioned, operated, or controlled at least in part by a user whilebeing positioned within a body cavity of a patient, including any devicethat is coupled to a support component such as a rod or other suchcomponent that is disposed through an opening or orifice of the bodycavity, also including any device positioned substantially against oradjacent to a wall of a body cavity of a patient, further including anysuch device that is internally actuated (having no external source ofmotive force), and additionally including any device that may be usedlaparoscopically or endoscopically during a surgical procedure. As usedherein, the terms “robot,” and “robotic device” shall refer to anydevice that can perform a task either automatically or in response to acommand.

Certain embodiments provide for insertion of the present invention intothe cavity while maintaining sufficient insufflation of the cavity.Further embodiments minimize the physical contact of the surgeon orsurgical users with the present invention during the insertion process.Other implementations enhance the safety of the insertion process forthe patient and the present invention. For example, some embodimentsprovide visualization of the present invention as it is being insertedinto the patient's cavity to ensure that no damaging contact occursbetween the system/device and the patient. In addition, certainembodiments allow for minimization of the incision size/length. Furtherimplementations reduce the complexity of the access/insertion procedureand/or the steps required for the procedure. Other embodiments relate todevices that have minimal profiles, minimal size, or are generallyminimal in function and appearance to enhance ease of handling and use.

Certain implementations disclosed herein relate to “combination” or“modular” medical devices that can be assembled in a variety ofconfigurations. For purposes of this application, both “combinationdevice” and “modular device” shall mean any medical device havingmodular or interchangeable components that can be arranged in a varietyof different configurations. The modular components and combinationdevices disclosed herein also include segmented triangular orquadrangular-shaped combination devices. These devices, which are madeup of modular components (also referred to herein as “segments”) thatare connected to create the triangular or quadrangular configuration,can provide leverage and/or stability during use while also providingfor substantial payload space within the device that can be used forlarger components or more operational components. As with the variouscombination devices disclosed and discussed above, according to oneembodiment these triangular or quadrangular devices can be positionedinside the body cavity of a patient in the same fashion as those devicesdiscussed and disclosed above.

Certain embodiments disclosed or contemplated herein can be used forcolon resection, a surgical procedure performed to treat patients withlower gastrointestinal diseases such as diverticulitis, Crohn's disease,inflammatory bowel disease and colon cancer. Approximately two-thirds ofknown colon resection procedures are performed via a completely opensurgical procedure involving an 8- to 12-inch incision and up to sixweeks of recovery time. Because of the complicated nature of theprocedure, existing robot-assisted surgical devices are rarely used forcolon resection surgeries, and manual laparoscopic approaches are onlyused in one-third of cases. In contrast, the various implementationsdisclosed herein can be used in a minimally invasive approach to avariety of procedures that are typically performed ‘open’ by knowntechnologies, with the potential to improve clinical outcomes and healthcare costs. Further, the various implementations disclosed herein can beused in place of the known mainframe-like laparoscopic surgical robotsthat reach into the body from outside the patient. That is theless-invasive robotic systems, methods, and devices disclosed hereinfeature small, self-contained surgical devices that are inserted intheir entireties through a single incision in the patient's abdomen.Designed to utilize existing tools and techniques familiar to surgeons,the devices disclosed herein will not require a dedicated operating roomor specialized infrastructure, and, because of their much smaller size,are expected to be significantly less expensive than existing roboticalternatives for laparoscopic surgery. Due to these technologicaladvances, the various embodiments herein could enable a minimallyinvasive approach to procedures performed in open surgery today.

The various embodiments are disclosed in additional detail in theattached figures, which include some written description therein.

The various system embodiments described herein are used to performrobotic surgery. The systems are used for general surgery applicationsin the abdominal cavity, including colon resection. In certainimplementations, the various systems described herein are based onand/or utilize techniques used in manual laparoscopic surgery includinginsufflation of the abdominal cavity and the use of ports to inserttools into the abdominal cavity.

Major components of the various system embodiments include a robot and asurgeon control console. The robot implementations are configured to beinserted into the insufflated abdominal cavity. Certain robotembodiments have an integrated camera system that captures a view of thesurgical target. The surgeon can then use that view on a display to helpcontrol the robot's movements. In certain implementations, the camera isdesigned so that it can be removed so it can be cleaned and used inother applications.

The surgeon console, according to some embodiments, has a display toview the feedback from the camera. This display can also have overlaysto provide some additional information to the surgeon including therobot's state and other information. The console can also have a touchscreen used to control various system functions. In addition, thevarious console embodiments can also have user input devices (e.g.haptic joysticks) that the surgeon can use to control the movement ofthe robot's arms and other movement. Further, the console can also hasone or more pedals used to control various robot control and functions.

In other embodiments as will be discussed in further detail herein, thesystem can include disposable or permanent sleeves, an electro-surgerycautery generator, an insertion port, a support arm/structure, a camera,remote surgical displays, end-effectors (tools), an interface pod, alight source, and other support components.

FIGS. 1A and 1B depict one embodiment of the system 1 with a robot orrobotic device 10 with a camera 12. As shown in FIG. 1A, the roboticdevice 10 has two robotic arms 14, 16 operably coupled thereto and acamera component or “camera” 12 disposed between the two arms 14, 16 andpositionable therein. That is, device 10 has a first (or “right”) arm 14and a second (or “left) arm 16, both of which are operably coupled tothe device 10 as discussed in additional detail below. The device 10 asshown has a casing (also referred to as a “cover” or “enclosure”) 11.The device 10 is also referred to as a “device body” 10A and has tworotatable cylindrical components (also referred to as “shoulders” or“turrets”): a first (or “right”) shoulder 14A and a second (or “left”)shoulder 16A. Each arm 14, 16 also has an upper arm (also referred toherein as an “inner arm,” “inner arm assembly,” “inner link,” “innerlink assembly,” “upper arm assembly,” “first link,” or “first linkassembly”) 14B, 16B, and a forearm (also referred to herein as an “outerarm,” “outer arm assembly,” “outer link,” “outer link assembly,”“forearm assembly,” “second link,” or “second link assembly”) 14C, 16C.The right upper arm 14B is operably coupled to the right shoulder 14A ofthe body 10A at the right shoulder joint 14D and the left upper arm 16Bis operably coupled to the left shoulder 16A of the body 10 at the leftshoulder joint 16D. Further, for each arm 14, 16, the forearm 14C, 16Cis rotatably coupled to the upper arm 14B, 16B at the elbow joint 14E,16E.

As shown in FIG. 1B, the robotic device 10 has been inserted into amodel of the abdominal cavity 6 through a gel port 7 in a fashionsimilar to the way it would be inserted into a patient's abdominalcavity 6. The gel port 7 allows for an irregularly shaped robotic device10 to be inserted while maintaining insufflation pressure. In thisimplementation, a standard manual laparoscopic port 7 is used inaddition to the robot 10. Alternatively, two or more such ports can beutilized (not shown). In a further alternative, no standard manuallaparoscopic ports are used.

In FIG. 1B, the device body 10A is shown having been inserted in aventral-dorsal orientation into the abdominal cavity such that thelongitudinal body axis (as is shown by reference arrow A) is generallyperpendicular relative to the rostrocaudal/anteroposterior andmediolateral axes (reference arrows B and C, respectively). It isunderstood that following insertion, the device body 10A can bevariously positioned, so as to be rotated, tilted or angled relative tothe cavity 6 to alter the device workspace and access various regions ofthe cavity, as is described in detail below in relation to FIGS. 6A-8C.

FIG. 2 shows the robot with the integrated camera system, according toone embodiment. The robot of FIG. 2 has two arms 14, 16 and a body 10A(or torso) having a distal end 10B and proximal end 10C. The arms 14, 16each have active degrees of freedom and an additional active joint 14F,16F to actuate the end effectors, or tools 18, 20. It is understood thatmore or less degrees of freedom could be included. The device in thisembodiment has a connection line 8 (also referred to as a “pigtailcable”) (partially shown) that includes electrical power,electrocautery, and information/communication signals. In certainimplementations, the device has distributed control electronics andsoftware to help control the device 10. Some buttons can be included tosupport insertion and extraction of the device into and out of theabdominal cavity. In this embodiment, the integrated camera 12 is alsoshown inserted in the device body 10A. When inserted into the body 10A,the camera 12 has a handle or body 12A that extends proximally from theproximal body end 10C and a flexible camera imager 12B extending fromthe distal body end 10B.

FIGS. 3 and 4 depict the robotic device 10 with the camera assembly 12removed, according to one embodiment. In these embodiments, and as shownin FIG. 2 and FIGS. 3-4 , the camera imager 12B is designed to bepositioned between the two arms 14, 16 and capture that view between thetwo arms 14, 16. In these implementations, the camera 12 extends throughthe robot body 10A such that the camera imager 12B exits near the jointsbetween the body and the robotic arms (the “shoulder” joints 14A, 16A).The camera 12 has a flexible, steerable tip 12C to allow the user toadjust the viewing direction. The end effectors 18, 20 on the distal endof the arms 14, 16 can include various tools 18, 20 (scissors, graspers,needle drivers, etc.). In certain embodiments, the tools 18, 20 aredesigned to be removable by a small twist of the tool knob that couplesthe end effector to the arm 14, 16.

As is shown in FIGS. 3-4 , the camera assembly 12 has a handle 12A and along shaft 12D with the camera imager 12B at the distal tip 12C. Invarious implementations, the flexible tip 12C and therefore cameraimager 12B can be steered or otherwise moved in two independentdirections in relation to the shaft 12D at a flexible section 12E (blacksection on shaft) to change the direction of view. In certainimplementations, the camera 12 has some control buttons 12F as shown. Insome embodiments, the camera assembly 12 can be used independently ofthe robotic device 10 as shown in FIG. 4 .

Alternatively, the assembly can be inserted into the robot 10 though alumen 10D defined through the body 10A of the robotic device 10 asshown. In certain embodiments, the lumen 10D includes a seal/port 10E toensure that the patient's cavity remains insufflated (as shown inrelation to FIG. 1B). According to one embodiment, the robotic device 10can have a sensor to determine if the camera is positioned in the cameralumen 10D of the device 10.

FIG. 5 depicts a robotic device 10 according to one embodiment in aconfiguration in which the positionable arms 14, 16 are positioned suchthat the tools 18, 20 are positioned in line with the camera tip 12C.That is, in this embodiment the arms 14, 16 are disposed in theworkspace so as to be within the field of view of the camera imager 12B(designated by reference lines “V₁” and “V₂”). In the implementation ofFIG. 5 , the device 10 is positioned within the cavity of the patient atan angle—that is, such that the longitudinal axis of the device body 10A(designated by reference line A) is not perpendicular to the body of thepatient (as shown, for example, in FIG. 1B).

In the implementation of FIG. 5A, the device body 10A is thereforeoriented so as to have a “top,” “upper,” or “front” side 22 and a“bottom,” “lower,” or “back” side 24. It is understood that furtherconfigurations are possible, and as described in detail herein, thecamera 12 and arms 14, 16 are capable of extending into either side 22,24 so as to provide large workspaces without the need to rotate thedevice body 10A.

In the implementation shown in FIG. 5B, the arms 14, 16 of the roboticdevice 10 are positioned in an “insertion” configuration. As shown, inthe insertion configuration, the arms 14, 16 and camera 12 are allprimarily aligned with the robotic device body 10A such that thelongitudinal axes of each of the components are substantially parallelto one another (as shown by reference arrow I) for insertion through theport (as is shown, for example, in FIG. 1B at 7). It is understood thatthe insertion configuration minimizes the overall “footprint” of thedevice 10, so as to allow the smallest possible incision. In certainimplementations, during insertion the device 10 can be passed through avariety of positions while being inserted, as has been previouslydescribed in U.S. patent application Ser. No. 15/227,813 filed Aug. 3,2016 and entitled “Robotic Surgical Devices, Systems, and RelatedMethods,” which is incorporated by reference herein in its entirety.

A principle advantage of the system 1 in certain implementations is awide workspace range for the arms, including embodiments wherein thearms are positioned “behind” the device. In use, increasing theworkspace range of each of the arms can reduce the need to reposition tothe device, and therefore lead to greater efficiency and faster totalsurgery times and recovery. Several implementations showing theincreased arm range are described herein.

FIGS. 6A, 6B, 7A, 7B, and 7C schematically depict the entire workspace30 as well as the individual reachable workspaces 30A, 30B of each ofthe arms 14, 16 of a robotic device 10, according to certainembodiments. In these embodiments, “workspace” 30 means the space 30around the robotic device 10 in which either arm and/or end effector 18,20 can move, access, and perform its function within that space.

More specifically, FIG. 6A depicts a perspective view of the device body10A and further schematically shows the entire workspace 30 as well asthe individual workspaces 30A, 30B of the first arm 14 and second arm16, respectively. Note that the each arm 14, 16 has a range of motionand corresponding workspace 30A, 30B that extends from the front 22 ofthe device to the back 24 of the device 10. Thus, the first arm 14equally to the front 22 and the back 24, through about 180° of spacerelative to the axis of the device body 10A for each arm 14, 16. Thisworkspace 30 allows the robotic device to work to the front 22 and back24 equally well without having to reposition the body 10A.

As best shown in FIG. 6B, the overlap of the ranges of motion for theindividual arms in these implementations also enables an intersectingworkspace 30C (as is also shown in FIG. 6A). It is understood that theintersecting workspace 30C in these implementations encompasses theworkspace 30C reachable by both arms 14, 16 and end effectors 18, 20 inany individual device 10 position. Again, in these implementations, theintersecting workspace 30C includes a range of about 180° of spacerelative to the axis of the device body 10A.

FIG. 7A depicts a side view of the device body 10A and furtherschematically shows the workspace 30A of the first arm 14. Note that thefirst arm 14 has a range of motion that extends from the front 22 of thedevice to the back 24 of the device 10. Thus, the first arm 14 equallyto the front 22 and the back 24. This allows the robotic device to workto the front 22 and back 24 equally well without having to repositionthe body 10A. With respect to the actual position of the arms 14, 16,FIG. 7A depicts the first arm 14 extending out from the front 22 of thedevice while the second arm 16 is extending out from the back 24.

Similarly, FIGS. 7B and 7C depict different views of the device body 10Aand arms 14, 16 of FIG. 7A. For example, FIG. 7B depicts a top view ofthe body 10A and arms 14, 16. In this embodiment, both the workspace 30Aof the first arm 14 and the workspace 30B of the second arm 16 are shownfrom a top view. Further, FIG. 7C depicts the body 10A and arms 14, 16from a perspective view that shows another angle of the workspaces 30A,30B.

In each of FIGS. 7A-7C, the same configuration of the body 10A and arms14, 16 is shown, with the first arm 14 extending out from the front 22of the device while the second arm 16 is extending out from the back 24(as best shown in FIG. 7A). This wide range of motion demonstrated bythe workspaces 30A, 30B for both of its arms 14, 16 gives the roboticdevice 10 a relatively large workspace when compared to the length ofits arms 14, 16.

FIGS. 8A, 8B, and 8C further depict the wide range of motion that can beachieved by the arms of this specific device 10, according to oneembodiment. FIG. 8A depicts a perspective view of the back of the device10 in which the arms 14, 16 are both depicted in a single position thatis substantially similar to that depicted in FIGS. 7A-7C: a first arm 14extends away from the front 22 of the device body 10A, while the secondarm 16 extends away from the back 24 of the device body 10A.

FIG. 8B depicts a side view of the device 10 in which the first arm 14is depicted in multiple different positions, including a first position14-1, a second position 14-2, a third position 14-3, and a fourthposition 14-4, thereby providing some examples of the range of motion ofwhich the arms (in this case, the first arm 14) are capable.

The implementation of FIG. 8C depicts a perspective front view of thedevice 10 in which the first arm 14 is again depicted in the samepositions as shown in FIG. 8B, including the first 14-1, second 14-2,third 14-3, and fourth 14-4 positions within the workspace 30A. One ofskill in the art would appreciate that many additional positions betweenthose shown are also possible, and that these positions of the first arm14 are also possible for the second arm 16.

FIG. 9 is a perspective front view of an implementation of the device 10with an articulating, or flexible camera 12 extending from the distalend 10B of the device body 10A. In these implementations, the camera 12has a distal lens 12B on the tip portion 12C, as well as a flexiblesheath 15 enclosing the flexible section 12E. In FIG. 9A, the camera 12and arms are generally oriented in a slightly “down” working position,wherein the tip portion 12C is oriented away from the front 22 of thebody 10A. Again, it is understood that in these implementations, thecamera 12 can therefore be positioned to best view the end effectors, ortools 18, 20. It is further understood that in these implementations therobot 10 exits the body on the forward surface 22.

FIG. 910 depicts a further implementation of the device 10 with the armsin an “up” or “normal” position, where the camera is angled slightlytoward the front 22 of the body 10A. Further, the device of FIG. 10 hasproximal sleeve attachments 32, 34 between the shoulders 14A, 16A anddevice body 10A. The sleeve attachments 32, 34 can be “grooves,” wheretwo flanges 32A, 32B, 34A, 34B are disposed around each shoulder shaft36, 38. It is understood that flanges 32A, 32B, 34A, 34B are configuredor otherwise constructed and arranged so that a permanent and/ordisposable sleeve (not shown, but as is discussed in the incorporatedreferences) can be attached and held in place between the respectiveflanges 32A, 32B, 34A, 34B. Corresponding distal mating areas 40, 42 foreach sleeve (not shown) are disposed on the distal ends of the forearms14C, 16C and at the base of each tool 18, 20.

FIG. 11 depicts a further implementation of a robot 10 having arms 14,16 positioned substantially “down,” compared to the positions of FIGS. 9and 10 . That is, in FIG. 11 , the camera tip 12C is orientedperpendicularly from the longitudinal axis (reference arrow A) of therobot body 10A on the back side 24 (as opposed to the front side 22)within a region of the workspace 30, and that the camera 12 disposedsuch that the arms 14, 16, and more specifically the tools, or endeffectors 18, 20 are within the field of view (shown generally withreference arrow V). In this implementation, various operations cables 45are also shown as being connected to the device body 10A and camera 12.

FIGS. 12A-F depict alternate implementations of the robot 10-1, 10-2. Inthe first implementation, and as shown in FIGS. 12A, 12C and 12E, therobot 10-1 has a sloped distal body 10B-1 portion 48 the camera 12extends from within. In the second implementation, as shown in FIGS.12B, 12D and 12F, the robot 10-2 camera 12 extends from the distal bodyend 10B-2. In these implementations, the arms 14, 16 have generallycylindrical upper links, or shoulders 14A, 16A disposed inparallel—laterally and separately—on the distal body end 10B such thatthere is a “gap” or opening 46 between the shoulders 14A, 16A. In theseimplementations, the camera 12 extends from the distal end of the devicebody 10B within the opening 46, so as to be directly between thegenerally cylindrical shoulders 14A, 16A and equidistant between thefront side 22 and back side 24. In these implementations, the camera 12can therefore be curved to view forward and rearward equally, as isshown, for example, in relation to FIG. 6A-8C.

FIGS. 13-30 depict the internal components of the body 10A, which isshown in these figures without its casing or housing 11. It isunderstood that in use, these implementations are covered, as is shownin relation to FIG. 1A. FIGS. 13-30 include the internal structural orsupport components of the body 10A. These components maintain thestructure of the body 12 and provide structural support for thecomponents disposed therein.

In use, there are many ways to actuate the robot 10 and its associatedcomponents, such as DC motors, AC motors, Permanent magnet DC motors,brushless motors, pneumatics, cables to remote motors, hydraulics, andthe like. A more detailed description of one possible system isdescribed in relation to FIGS. 13-30 . Other technologies described inthe previously-filed and incorporated applications and patents can alsobe implemented to actuate the various components, as would beunderstood.

FIG. 13 shows an implementation of the robot 10 and each joint of onearm—here, the left arm 16. it is understood that the right arm 14 ofthis implementation is a mirror image of the left 16. It is understoodthat the internal components in the left arm 16 thatoperate/control/actuate the left arm 16 are substantially the same asthose depicted and described herein and that the descriptions providedbelow apply equally to those components as well.

In the implementation of FIG. 14 , a shoulder yaw joint 100 actuates ayaw joint 100 in the robot shoulder 14A, 16A. In this implementation,the robot 10 also has a shoulder pitch joint 102, that is, a pitch joint102 on the robot shoulder 14A, 16A. In these implementations, an upperarm roll joint 104, an elbow joint 106, and a tool roll joint 108 arealso provided which enable the range of motion described in relation toTable 1, below. In various implementations, a tool actuation joint (notshown) interfaces with the tool (not shown) to actuate open and close ofthe tool, as has been previously described.

In various implementations, these joints 100, 102, 104, 106 havepractical defined ranges of motions that, together with the robotgeometry, lead to the final workspace of the robot 10. For the examplesgiven herein, the joint limits allow for a significant robot workspace,as is described above. This workspace allows the various implementationsof the robot to use both arms and hands effectively in several locationswithin the body cavity of the patient. The joint ranges of motiondefined in the implementations of FIGS. 13A-27 are given in Table 1. Itis understood that further ranges are possible, and so this set ofranges is not limiting, but rather representative of a particularembodiment. Further, alternate embodiments are possible.

The direction of rotation and zero positions are shown in FIGS. 13A-D.In FIGS. 13A-D, the robot 10 is shown with each of the first four anglesin the zero location. In these implementations, each joint (the shoulderyaw joint 100, shoulder roll joint 102, upper arm roll joint 104 andelbow joint 106) is shown with an axis of rotation (dotted) and a zerolocation. An arrow is then used to indicate the direction of positivejoint angle about the axis of rotation. Since the tool roll joint 108and tool actuation joints 109 are allow continuous rotation the zerolocation is arbitrary and not shown.

TABLE 1 Joint Ranges of Motion Joint No. Range of Motion 1 −90 to +90 2−90 to +30 3 −90 to +90 4 0 to 150 5 Continuous 6 Continuous

In the implementation of FIG. 14 , the body 10A and each link (meaningthe upper arm 16B, and forearm 16C) contain Printed Circuit Boards(“PCBs”) 110, 112, 114 that have embedded sensor, amplification, andcontrol electronics. One PCB is in each forearm and upper arm and twoPCBs are in the body. Each PCB also has a full 6 axisaccelerometer-based Inertial Measurement Unit and temperature sensorsthat can be used to monitor the temperature of the motors. Each jointcan also have either an absolute position sensor or an incrementalposition sensor or both. In certain implementations, the some jointscontain both absolute position sensors (magnetic encoders) andincremental sensors (hall effect). In other implementations, certainjoints only have incremental sensors. These sensors are used for motorcontrol. The joints could also contain many other types of sensors. Amore detailed description of one possible method is included here.

In this implementation, a larger PCB 110 is mounted to the posteriorside of the body 10A. This body PCB 110 controls the motors 116 in thebase link, or body 10A (the shoulder yaw joint 100 and shoulder pitchjoint 102 for left and right arms, respectively). Each upper arm has aPCB 112 to control the upper arm roll joint 104 and elbow joint 106.Each forearm has a PCB 114 to control the tool roll joint 108 and toolactuation joint (not shown). In the implementation of FIG. 14 , each PCB110, 112, 114 also has a full six axis accelerometer-based inertialmeasurement unit and several temperature sensors that can be used tomonitor the temperature of the various motors described herein.

In these embodiments, each joint 100, 102, 104, 106, 108 can also haveeither an absolute position sensor or an incremental position sensor orboth, as described and otherwise disclosed in U.S. ProvisionalApplication 61,680,809, filed on Aug. 8, 2012, which is herebyincorporated herein by reference in its entirety. In one implementation,and as shown in FIG. 15 and elsewhere the various actuators or motors116, 130, 154, 178 described herein have at least one temperature sensor101 disposed on the surface of the motor, for example bytemperature-sensitive epoxy, such that the temperature sensors (as shownin FIG. 22 at 101) can collect temperature information from eachactuator for transmission to the control unit, as discussed below. Inone embodiment, any of the motors discussed and depicted herein can bebrush or brushless motors. Further, the motors can be, for example, 6mm, 8 mm, or 10 mm diameter motors. Alternatively, any known size thatcan be integrated into a medical device can be used. In a furtheralternative, the actuators can be any known actuators used in medicaldevices to actuate movement or action of a component. Examples of motorsthat could be used for the motors described herein include the EC 10BLDC+GP10A Planetary Gearhead, EC 8 BLDC+GP8A Planetary Gearhead, or EC6 BLDC+GP6A Planetary Gearhead, all of which are commercially availablefrom Maxon Motors, located in Fall River, MA. There are many ways toactuate these motions, such as with DC motors, AC motors, permanentmagnet DC motors, brushless motors, pneumatics, cables to remote motors,hydraulics, and the like. Further implementations can be used inconjunction with the various systems, methods and devices disclosed inU.S. patent application Ser. No. 15/227,813 filed Aug. 3, 2016 andentitled “Robotic Surgical Devices, Systems, and Related Methods,” whichis incorporated by reference in its entirety.

In this implementation, joints 1-4 have both absolute position sensors(magnetic encoders) and incremental sensors (hall effect). Joints 5 & 6only have incremental sensors. These sensors are used for motor control.It is understood that the joints could also contain many other types ofsensors, as have been described in detail in the incorporatedapplications and references.

According to one implementation, certain other internal componentsdepicted in the implementation of FIGS. 15-16 are configured to actuatethe rotation of the shoulder yaw joint 100 of the body 10A around axis1, as shown in FIG. 14 . It is understood that two of each of thedescribed components are used—one for each arm—but for ease ofdescription, in certain depictions and descriptions, only one is used.

As best shown in FIG. 15 , a shoulder yaw joint 100 motor 116 andgearhead combination drives a motor gear 117 first spur gear set 118,which is best shown in FIG. 16 . The first spur gear set 118 drives ashaft supported by bearings 120 to drive a second spur gear set 122. Inturn, this second spur gear set 122 drives an output shaft 124 that isalso supported by bearings 126. This output shaft 124 then drives aturret 14A, 16A (representing the shoulder of the robot 10) such thatthe shoulder 16A rotates around axis 1, as best shown in FIG. 14 .

According to one implementation, certain internal components depicted inthe implementation of FIGS. 17-19 are configured to actuate the shoulderpitch joint 102 of the body 10A and/or shoulder 14A, 16A around axis 2,as is shown in FIG. 14 . In these implementations, the pitch joint 102is constructed and arranged to pivot the output link 140 so as to movethe upper arm (not shown) relative to the shoulder 14A, 16A.

In this implementation, a motor 130 and gearhead combination drives amotor gear 131 and spur gear 132 that in turn drives a first shaft 134.This shaft 134 then drives a bevel (or miter) gear pair 136, 137 insidethe shoulder turret (depicted in FIG. 19 ). The bevel (or miter) gearpair 136, 137 accordingly drives a helical spur set 138, 139 directlyconnected to the shoulder pitch joint 102 output link 140, such that theupper arm 16B rotates around axis 2, as best shown in FIG. 14 . In thisimplementation, the shoulder yaw joint 100 and the shoulder pitch joint102 therefore have coupled motion. In these implementations, a pluralityof bearings 141 support the various gears and other components, as hasbeen previously described.

FIGS. 20-23 depict various internal components of the upper arm 16Bconstructed and arranged for the movement and operation of the arm 16.In various implementations, multiple actuators or motors 142, 154 aredisposed within the housing (not shown) of the forearm 16C. FIGS. 24-27depict various internal components of the forearm 16C constructed andarranged for the movement and operation of the end effectors. In variousimplementations, multiple actuators or motors 175, 178 are disposedwithin the housing (not shown) of the forearm 16C.

In one implementation, and as shown in FIG. 22 and elsewhere the variousactuators or motors 116, 130, 154, 178 described herein have at leastone temperature sensor 101 disposed on the surface of the motor, forexample by temperature-sensitive epoxy, such that the temperaturesensors can collect temperature information from each actuator fortransmission to the control unit, as discussed below. In one embodiment,any of the motors discussed and depicted herein can be brush orbrushless motors. Further, the motors can be, for example, 6 mm, 8 mm,or 10 mm diameter motors. Alternatively, any known size that can beintegrated into a medical device can be used. In a further alternative,the actuators can be any known actuators used in medical devices toactuate movement or action of a component. Examples of motors that couldbe used for the motors described herein include the EC 10 BLDC+GP10APlanetary Gearhead, EC 8 BLDC+GP8A Planetary Gearhead, or EC 6 BLDC+GP6APlanetary Gearhead, all of which are commercially available from MaxonMotors, located in Fall River, MA. There are many ways to actuate thesemotions, such as with DC motors, AC motors, permanent magnet DC motors,brushless motors, pneumatics, cables to remote motors, hydraulics, andthe like.

One implementation of the internal components of the upper arm 16Bconstructed and arranged to actuate the upper arm roll joint 104 isshown in FIGS. 20-21 . In this implementation, a motor 142 and gearheadcombination controlled by a PCB 112 drives a motor gear 143 andcorresponding spur gear 144 where the output spur gear 144 is supportedby a shaft 148 and bearings 150. The output shaft 152 and output spurgear 144 can have a mating feature 146 that mates to the shoulder pitchjoint 102 output link 140 (shown in FIG. 17 ).

One implementation of the internal components of the upper arm 16Bconfigured to operate the elbow joint 106 is shown in FIGS. 22-23 . Inthis implementation, a base motor 154 directly drives a driven spur gearset that includes three gears 156, 158, 160. This spur gear set 156,158, 160 transfers the axis of rotation from the axis of the motor 154to the axis of a worm gear 166.

As best shown in FIG. 23 , the output spur gear 160 from this set drivesa motor gearhead 162 that drives a worm shaft 164 that has a worm gear166 mounted on it. This worm gear 166 then drives a worm wheel 168 thatis connected to the Joint 4 output shaft 170. It should also be notedthat the upper arm unit (as shown in FIG. 22 ) shows a curved concaveregion 172 on the right side. It is understood that this region 172 isconfigured to allow for a larger motion of Joint 4 so as to allow theforearm to pass through the region 172.

One implementation of the internal components of the forearm 16Cconfigured or otherwise constructed and arranged to operate the toolroll joint 108 is shown in FIGS. 24-25 . In these implementations, thetool roll joint 108 drives a tool lumen 174 that holds the tool (shown,for example, at 18, 20 in FIGS. 1A-1B). The tool lumen 174 is designedto mesh with the roll features on the tool to cause the tool to rotateabout its axis, as shown as axis 5 in FIG. 14 . In this implementation,a tool roll motor 175 with a gearhead is used to drive a motor gear 176and spur gear chain with two gears 177A, 177B. The last gear of thischain 177B is rigidly mounted to the tool lumen 174, so as to rotate theinner surface 174A of the tool lumen, and correspondingly any insertedend effector.

One implementation of a tool actuation joint 109 is shown in FIGS. 26-27. In this implementation, the Joint 6 motor 178 does not visibly movethe robot. Instead, this tool actuation joint 109 drives a female spline184 that interfaces with the tool (Shown, for example, at 18, 20 inFIGS. 1A-1B) and is configured to actuate the end effector to open andclose. This rotation of the end effector arms such that the end effectoropens and closes is also called “tool drive.” The actuation, in oneaspect, is created as follows. An actuator 178 is provided that is, inthis implementation, a motor assembly 178. The motor assembly 178 isoperably coupled to the motor gear 180, which is a spur gear in thisembodiment. The motor gear 180 is coupled to first 182 and second 183driven gears such that rotation of the motor gear 180 causes rotation ofthe driven gears 182, 183. The driven gears 182, 183 are fixedly coupledto a female tool spline 184, which is supported by bearing pair 186. Thefemale tool spline 184 is configured to interface with a male toolspline feature on the end effector to open/close the tool as directed.

According to one implementation, the end effector (shown at FIGS. 1A-1Bat 18, 20) can be quickly and easily coupled to and uncoupled from theforearm 16C in the following fashion. With both the roll and drive axesfixed or held in position, the end effector 18, 20 can be rotated,thereby coupling or uncoupling the threads (not shown). That is, if theend effector is rotated in one direction, the end effector is coupled tothe forearm 16B, and if it is rotated in the other direction, the endeffector is uncoupled from the forearm 16B.

Various implementations of the system 10 are also designed to deliverenergy to the end effectors so as to cut and coagulate tissue duringsurgery. This is sometimes called cautery and can come in manyelectrical forms as well as thermal energy, ultrasonic energy, and RFenergy all of which are intended for the robot.

In exemplary implementations of the system 1 and various devices 10, thecamera 12 is configured or otherwise constructed and arranged to allowfor both pitch (meaning “up” and “down”) movements and yaw (meaning“side to side” movements) within the workspace 30, and in exemplaryimplementations, the yaw or “pan” functionality is accomplished viamechanical articulation at the distal tip 12C, rather than via rotatingthe camera shaft 12D and/or handle 12A, as has been done previously.Accordingly, various implementations of the camera component 12 of thisimplementation have two mechanical degrees of freedom: yaw (lookleft/right) and tilt (look up/down). In use, the camera component 12 haspan and tilt functionality powered and controlled by the actuators andelectronics in the handle 12A, as has been previously described in U.S.patent application Ser. No. 15/227,813. In these implementations of thesystem, the camera 12 is therefore able to allow the user to observe thedevice arms and end effectors throughout the expanded workspace. Severaldevices, systems and methods allowing for this improved range of visionand camera movement are described herein.

Various implementations and components of the camera are shown in FIGS.28A-36C and elsewhere. As discussed above, the camera 12 of certainimplementations is designed to function with the robot 10, as is shownin FIG. 2 . The robot camera 12 can also be used independent of therobot, as shown FIG. 4 . In various implementations, the camera 12 isinserted into the proximal end 10C of the robot body 10A, and as isshown in FIG. 28A, the camera tip 12C exits through the distal end 10Bof the robot body 10A near the attachment location between the body andarms, as described above in relation to FIG. 6 . In certainimplementations, and as discussed in relation to FIG. 3 , a seal 10E isincluded in the robot body 10A so as not to lose insufflation when thecamera 12 is removed from the robot 10. Several diameters are possible,but one implementation has a 5 mm camera that is inserted into a 6 mmlumen 10D in the robot, as is shown in FIG. 28A.

In the implementations of FIGS. 28A-B, the camera 12 is designed to flexin two independent degrees of freedom at the distal end 12C. This allowsthe user to visualize the robot tools at any position within the robotworkspace via the imager 12B, as shown at 1°-V° in FIG. 28B. In theseimplementations, the robot lumen 10D may be centered with respect to therobot body 10A, as shown in FIGS. 28A-B, allowing for symmetric pointsof view with respect to the robot arms, or it may be more anterior, asshown in the implementation of FIG. 1A, or posterior or in otherlocations.

Additionally, as shown in FIGS. 28A-28B the camera 12 tip 12C containsone or more lighting components 12F to light the viewing target (asdiscussed in relation to FIG. 1 ). In these implementations, thelighting components 12F can be illuminated via an independent light boxor some other known light source (not shown, but one non-limitingexample is high bright LEDs) in the camera handle or other forms oflight sources. The light can then be directed through the camera shaft12 via fiber optic cables, as has been previously described, for examplein relation to U.S. patent application Ser. No. 15/227,813 filed Aug. 3,2016 and entitled “Robotic Surgical Devices, Systems, and RelatedMethods,” which is incorporated by reference.

An additional feature of certain implementations allows the camera 12 tobe inserted into the body 10A with various depths. These implementationsallow for better visualization during various activities. For example,FIGS. 28C-28E, 28F-28H and FIG. 28I show several implementations of acamera 12 that can be inserted at several depths, which can includefixed locations to hold the camera 12 using one ore more projections 70such as spring balls 70 disposed on the exterior surface of the camerabody 12A, and corresponding fixed ring detents 72 (best shown in FIG.28I) disposed at a variety of depths inside the body lumen 10D. In use,the detents 72 that engage the balls 70 at various degrees of insertiondepth (reference arrow H). This would allow the camera to be moreproximal with respect to the robot arms (FIGS. 28C-E) or more distalwith respect to the robot arms (FIG. 28F-28H). It is understood that inalternate implementations, other methods of disposing the camera 12 arepossible, including a continuous movement and other systems actuatedwith various actuation and control mechanisms.

In various implementations of the camera handle 12, over molds may beprovided for user comfort. Various connector and button and pigtailcombinations are possible. In certain implementations, the camera handle12A holds at least one motor to actuate the flexible tip 12C. In oneversion these motors can then be controlled via the surgeon console (asdescribed below) or other input devices to control the motion of thecamera 12. This control could also include other camera functions suchas zoom, brightness, contrast, light intensity, and many other features.

As shown in FIGS. 29A-29B, the camera system's flexible articulated tip12C allows the camera 12 to achieve fields of view (reference arrow V)over substantially all of the robot workspace 30. In theseimplementations, a cross section of one possible workspace in thesagittal plane is shown. FIGS. 29A-29B demonstrate the movement of therobot arms 14, 16 can move about a large workspace 30 and the camerasystem 12 must be able to visualize the robot tools 18, 20 at all times.

FIGS. 30A-33C depict several embodiments of the device 10, wherein thecamera 12 is alternately oriented to allow for consistent toolvisualization throughout the surgical theater. It is understood thatthis visualization requirement can be met through variousimplementations, and that many imager configurations are possible.

The imager 12B-1 of the implementations of FIGS. 30A-30F is referred toas a “zero degree scope” imager 12B-1, meaning that the line of viewing(shown with reference area V) is aligned normally with the distal tip12C of the camera 12. FIGS. 30A-30F depict the sagittal plane of a robot10 design with the camera 12C having a zero degree imager 12B-1following the motion of the robot 10 from “behind” (at −90°) the robot10 (FIG. 30A) to “bellow” (at 0°) the robot (at FIG. 30D) and in “front”(at 90°) of the robot 602 at FIG. 30F. FIGS. 30B, 30C and 30E depict thedevice 10 at −60°, −45°, and 45°, respectively. It is understood that inthe implementation of FIGS. 30A-30F, the camera tip 12C is oriented soas to place the end effector 20 into the field of view V at eachposition.

The imager 12B-2 of the implementations of FIGS. 31A-31F is referred toas a “30 degree scope” imager 12B-2, meaning that the line of viewing(shown with reference area V) is aligned 30° from the distal tip 12C ofthe camera 12, as would be understood by one of skill in the art. FIGS.31A-31F depict the sagittal plane of a robot 10 design with the camera12C having a zero degree imager 12B following the motion of the robot 10from “behind” (at −90°) the robot 10 (FIG. 31A) to “bellow” (at 0°) therobot (at FIG. 31D) and in “front” (at 90°) of the robot 602 at FIG.31F. FIGS. 31B, 31C and 31E depict the device 10 at −60°, −45°, and 45°,respectively. It is understood that in the implementation of FIGS.31A-31F, the camera tip 12C is oriented so as to place the end effector20 into the field of view V at each position.

The imager 12B-3 of the implementations of FIGS. 32A-32F is referred toas a “60 degree scope” imager 12B-3, meaning that the line of viewing(shown with reference area V) is aligned 60° from the distal tip 12C ofthe camera 12, as would be understood by one of skill in the art. FIGS.32A-32F depict the sagittal plane of a robot 10 design with the camera12C having a zero degree imager 12B following the motion of the robot 10from “behind” (at −90°) the robot 10 (FIG. 32A) to “bellow” (at 0°) therobot (at FIG. 32D) and in “front” (at 90°) of the robot 10 at FIG. 32F.FIGS. 32B, 32C and 32E depict the device 10 at −60°, −45°, and 45°,respectively. It is understood that in the implementation of FIGS.32A-32F, the camera tip 12C is oriented so as to place the end effector20 into the field of view V at each position.

FIGS. 33A-33B depict an alternate implementation of the robot 10 whereinthe distal camera imager 12B and tip 12C can make an “S-curve” shape.This implementation may require an extra actuated degree of freedom incertain implementations, but it is understood that it has the ability toprovide improved viewpoints (shown by reference area V) by allowing thecamera 12B to be moved from the plane of (or otherwise being coaxialwith) the robot arms 16 and end effectors 20. It is understood thatthere are various advantages to offsetting the camera tip 12C axis fromany individual arm 14, 16 or end effector axis, such as to view variousinternal tissues, organs and the like within the surgical theater.

Turning to the articulation of the camera tip 12C, FIGS. 34A-34C depictvarious internal components and devices used to achieve the camera 12movements shown in FIGS. 31A-33B and elsewhere. Again, because of thelarge workspaces possible in certain implementations (as discussed forexample in relation to FIGS. 6A-6B at 30) exemplary implementations ofthe camera 12 are configured or otherwise constructed and arranged toallow for both pitch (meaning “up” and “down”) movements and pan or yaw(meaning “side to side” movements) within the workspace 30. In theseimplementations of the system, the camera is therefore able to allow theuser to observe the device arms and end effectors throughout theexpanded workspace. Several devices, systems and methods allowing forthis improved range of vision and camera movement are described herein.As would be understood by one of skill in the art, the present examplesare non-limiting, and are shown for purposes of illustration without theprotective sheath (shown, for example, in FIG. 9A at 15).

The pitch and yaw articulation of the camera tip 12C can be achievedthrough various implementations, as shown in FIGS. 34A-34C. FIGS.34A-34B show continuum mechanisms. In the implementation of FIG. 34A,the camera is able to articulate at the tip 12C. In this implementation,the camera tip 12C via an articulating portion 202 defining a cameralumen 204 and comprising a plurality of openings 206A, 206B on eitherside of the portion so as to allow the device to flex in the possibledirections (as shown by reference arrows A and B. It is understood thatin these implementations, the articulating portion 202 can be caused tomove or articulate in either direction (A or B) via cables 208A, 208Bdisposed through the camera lumen 204 and actuated via motors disposedwithin the camera handle 12A. It is further understood that additionalcomponents such as wires, fiber optics and the like can also be disposedthrough this lumen 204.

In the implementation of FIG. 34B, the articulating portion has severalspacers 212 surrounding an internal tube 214 defining a camera lumen204. In these implementations, a plurality of cables 208A, 208B, 208C,208D are disposed through openings 216A, 216B, 216C, 216D in the spacers212. As would be appreciated by one of skill in the art, in theseimplementations the cables are fixedly attached to the most distalspacer 212 and are allowed to pass through the more proximal spacers,such that proximal movement of the cables 208 results in articulation ofthe portion 202. Various methods for urging the cables 208 proximallyhave been previously described, for example in relation to U.S. patentapplication Ser. No. 15/227,813 filed Aug. 3, 2016 and entitled “RoboticSurgical Devices, Systems, and Related Methods,” which is incorporatedby reference.

The implementation of FIG. 34C has a “stack” of interlocking linkages220 disposed within the portion 202. In these implementations, thelinkages 220 have corresponding vertical 222A and horizontal 222Barticulating links on adjacent links 220A, 220B that are configured toallow the proper degrees of freedom, as would be understood andappreciated by one of skill in the art. In these implementations, cables(not shown) can be run through openings 224 in the links 222, as hasbeen previously described. It is understood that these variousimplementations of the articulating portion allow for the adjustment ofcamera pitch and yaw in various degrees of freedom so as to enable thecamera to view several fields of view within the workspace withoutrepositioning the camera body or device.

Further, the depth to which the camera 12 is inserted into the device 10can be varied. FIGS. 35A-C show how the depths of the camera 12 can bevaried to change the vantage point (reference arrow V). For example, asshown in FIG. 35A, the camera 12 can be fully inserted into the robot10A with the imager 12B coaxial with the lumen 10D during insertion to“self visualize” the insertion process. In use, self visualizationallows the user to view the tool tips during insertion. When in this“insertion” position, the imager 12B reaches the maximum distance fromthe “plunge line” 230 (shown by reference arrow A).

As shown in FIGS. 35B-35C, a forward working position (FIG. 35B) and abackward working position (FIG. 35C) are also possible, with the fieldof view (reference area V) adjusted correspondingly. In the depictedimplementation, the camera 12 motion can be manual or motorized andcontrolled. As is also shown in FIGS. 35B-35C, in certainimplementations of the device 10 where the camera extends from a portionon the front side of the device (like that shown in FIG. 1A), the cameratip depth will vary between frontward and backward viewing positions, asis designated by reference arrow B. In certain implementations, and asis also described in relation to FIGS. 28A-I, the height of the camera12 within the workspace can also be adjusted to correct for thisdiscrepancy.

Various implementations of the system have a variety of tools, or endeffectors 18, 20 disposed at the distal ends of the arms. Exemplaryimplementations feature interchangeable end effectors or “hands”. Inthese implementations, the robot “hands” can include various tools suchas scissors, graspers, needle drivers, and the like. In variousimplementations, the tools are designed to be removable by a small twistof the tool knob 250, such as via a ¼ turn bayonet connection. The toolsgenerally have two actuated and controlled degrees of freedom withrespect to the forearm. It is understood that in variousimplementations, the tools can also have no degrees of freedom or one ormore degrees of freedom. In various implementations, the tools arecontrolled via the user input devices on the control console, as hasbeen previously described. The first degree of freedom allows the toolsto roll about their own axis (shown at reference arrow R). One type oftool used in this robot has one degree of freedom. This tool 18, 20,shown in FIG. 36A-B, is based on hook cautery from manual laparoscopictools, and has a roll interface 252 and monopolar slip ring 254. Certainimplementations of the tool 18, 20 can roll (reference arrow R), butdoes not have an open close function. Many additional end effectorimplementations are contemplated herein, as are described in the severalincorporated references.

In use, according to certain implementations, the distal end 10B of thedevice body 10A and arms 14, 16 are disposed within the patient bodycavity, so as to be operated remotely by the user via console, as isdescribed below. The user—typically a surgeon—positions the device 10body within the cavity at a fixed initial starting position, and in someimplementations, is thereafter able to re-position the device asdesired. In certain implementations, and as described herein, thevarious support systems described herein utilize “remote center” or“point tracing” approaches to maintain the desired position andorientation of the robot relative to a specific point throughre-positioning, such as a remote point and/or the incision or insertionpoint. In certain implementations, the remote centering is maintained byconstraining the movements of the support structure as it moves throughseveral degrees of freedom, while certain point tracing implementationsimpose additional movements onto the support structure to maintain theposition. It is understood that certain implementations can involvecombinations of these and other approaches. Several illustrative systemsand methods for securing, positioning and repositioning the device 10are described herein.

As shown in FIG. 37 , in various implementations the robot 10 can besupported in place with FIG. 37 shows one method or device forsupporting the robot 10 with a known clamp/support system 302 attachedto the operating room table 303. The clamp system 302 allows forsignificant adjustment of the location of the robot in all six degreesof freedom possible for the robot body. It is understood that otherknown, commercially-available support systems can be used to hold anyrobotic device embodiment disclosed or contemplated herein (such as, forexample, robot 10). Such known devices typically hold manuallaparoscopic instruments such as scopes, tools, and retractors, and cansimilarly be used to clamp to or otherwise support the robot 10 or othersuch robotic device embodiments.

FIGS. 38-39 show one embodiment of a remote center mechanism 304,sometimes called a “point tracing mechanism,” or “positioning system”that could be used to support the robot 10. One advantage of the remotecenter mechanism 304, in accordance with one implementation, is that themechanism 304 can be used to move the device 10 while a single point ofthe robot 10 assembly remains in the same location: the remote center318 of the mechanism 304 as best shown in FIG. 38 . In use, themechanism 304 is typically positioned such that the remote center 318 ispositioned at the insertion point 315 in the patient, as best shown inFIG. 39 . With the remote center 318 at the insertion point 315, therobot 10 has about three degrees of freedom about this insertion point318 and one in/out translation through the insertion point 315 and port301. In these implementations, the insertion point 315 can be adjustedin several ways such as by moving the mechanism 304 with respect to theoperating room bed rail to align the remote center 318 with theinsertion point 315 on the patient. The remote center 318 results, inone embodiment, from all joints of the mechanism 304 (shown at Joint 1,2, 3, & 4 in FIG. 38 ), being designed to intersect with that remotecenter 318. As shown in FIG. 38 according to one implementation, joints1-3 are rotational joints (in which Joint 2 is a special parallelogrammechanism) and joint 4 is a translational joint that controls the robotinsertion depth into the abdominal cavity. According to any remotecenter mechanism implementation as disclosed or contemplated herein, theremote center 318 can eliminate or reduce mechanical interferencebetween the robot 10 and the abdominal wall 316 that might be createdwhen the robot 10 is being moved.

FIGS. 40A and 40B show the positioning of the robot 10 with respect tothe abdominal wall 316, according to certain implementations. In theseimplementations, a remote center positioning device 304 (and any otherpositioning device embodiment disclosed or contemplated herein) allowthe robotic device 10 to access the full extent of the workspace 30within the cavity 316. In these implementations, the positioning device304 has several linkages and links 305, 306, 307, 308, 309 including asupport link 310 in mechanical communication with the device 10 andjoints 311, 312, 313 including a support joint 314 in mechanicalcommunication with the support link 310. In these implementations, thelinks 305, 306, 307, 308, 309, 310 and joints 311, 312, 313, 314 are inmechanical communication with one another and with a support pivot 319,so as to be capable of movement in at least three degrees of freedom,and with the rotation of the device 10, a fourth degree of freedom.

That is, the positioning device 304 makes it possible to position therobotic device 10 within the patient's cavity 316 with the body 10A ofthe device 10 positioned through the incision 315 (or port disposed inthe incision 315) such that the end effectors 18, 20 attached to thearms 14, 16 of the robotic device 10 can reach any desired location inthe workspace 30 while the links 305, 306, 307, 308, 309, 310 and joints311, 312, 313, 314 of the positioning device 304 function to create theremote center 318 where the device body 10A passes through the incision315 such that all movements of the robotic device 22 pass through theremote center 318 at a single point, such as the insertion point 315. Inother words, regardless of the positioning of the links 305, 306, 307,308, 309, 310 and joints 311, 312, 313, 314 and the resultingpositioning of the robotic device 10 within the patient's cavity 316,the portion of the device body 10A at the incision 315 (the remotecenter 318) remains in the same position in all three axes (through theincision 315) as a result of the positioning device 304. This allowsoperation of a robotic device (such as robotic device 10) within acavity (such as cavity 316) such that the end effectors (such as endeffectors 18, 20) can reach any desired location within the cavity whilethe entire device 10 is connected to the positioning device 304 via adevice body 10A that passes through and never moves from a single point(remote center 318) at the incision 315, thereby making it possible tooperate and position the device 10 through that single incision (such asincision 315). Another advantage is that the positioning device 304makes it possible to use the single in vivo robotic device within thepatient's cavity instead of the multiple arms of the known Da Vinci™system extending from the patient's cavity and thereby taking up a greatdeal of workspace outside the body of the patient.

FIGS. 41A and 41B show further implementations of the support device 304that can be used to support the robot 10. In these implementations, oneor more motors 301A, 301B can be operationally integrated with a supportmechanism 304 such that the links 305, 306, 307, 308, 309, 310 andjoints 311, 312, 313, 314. It is understood that in theseimplementations, the motors 301A, 301B are able to drive the linkagesinto various controlled positions, that is to “point trace” on theincision point 318 through three or four (including device roll) degreesof freedom. That is, the actuators or motors 301A, 301B can beconfigured to drive the links 305, 306, 307, 308, 309, 310 and joints311, 312, 313, 314 in a coordinated fashion through yaw, pitch androtational degrees of freedom, so as to maintain the position the robot10 relative to the remote point 318.

The support structure 304 of FIGS. 42A-42C also utilizes one or moremotors 301A, 301B to maintain the position of the device 10 relative tothe remote point 318, according to certain implementations. Again, inthese implementations, the support structure 304 has links 305, 306,307, 308, 309, 310 and joints 311, 312, 313, 314, including a trackedjoint 326 that is in operational communication with a pitch track 322having a track opening 324. It is understood that in theseimplementations, the movement of the links 305, 306, 307, 308, 309, 310urges the support joint 326 through various positions on the trackopening 324 to reposition the device 10 while point tracing at theremote point 318. It is understood that many implementations of thelinkages and/or joints are possible.

The implementations of FIGS. 43 and 44 depict a positioning and supportstructure embodiment referred to as the “desk lamp” 304. It isunderstood that this implementation has similar kinematics to a desklamp, in that in these implementations, the links 330, 332, 334, 336,338, 340, 342, 344, 346 are able to move in a controlled fashionrelative to the handle 12A and/or robot 10, so as to adjust the pitch orother position of the robot 10 while maintaining a consistent positionrelative to the insertion point 318. In certain implementations, springscan be used to counterbalance the weight of the robot 10. As shown inFIG. 44 , in certain of these support devices 304, a plurality of cables350, 352, 354 can be used to drive the linkages, such as via an actuatedspindle 360 or other device. That is, various implementations, actuators301A, 301B can be operationally connected to a cables 350, 352, 354 todrive these motions of the links 330, 332, 334, 336, 338, 340, 342, 344,346.

Of course all of the support mechanisms described herein can be actuatedwith electric motors or other actuators. Each joint, or any combinationof the joints, could be driven by an electric motor. Sensors could alsobe used at some or all of the joints to create a control system. Thiscontrol system can then be connected to the robot control system so thatthe support mechanism control and the robot control could be coordinatedto allow both systems to work together so as to extend the workspace ofthe robotic device through the robot controls (or other controls) on theconsole or in a separate control system.

As shown in FIG. 45 , in further alternate implementations, the roboticdevice 10 can be supported by an exterior robot 360. Here, the roboticdevice 10 is supported by an external robot arm 362 having several links362, 364, 366 that have one or more degrees of freedom each, and can beused to remote center or point trace the robot during the surgicalprocedure. In various implementations, the arm(s) are activelycontrolled by motors, sensors, and a control system, such as thatdescribed herein. It is understood that this external robot 360 incertain implementations can be another surgical robot 360, an industrialrobot, or a custom robot. It is further understood that the externalrobot 360 in this system 1 could be used in conjunction with othersurgical devices and robotic surgical systems, such as laparoscopes 3365or other known surgical tools and devices. Another version of theexternal robot support robot 360 could be a parallel linkage externalrobot 370, as is shown in the implementation of FIG. 46 .

The parallel linkage external robot 370 of FIG. 46 has an above-mountedrobot 370 that in certain implementations is mounted to the ceilingabove the surgical theater. In various implementations, a plurality ofradially-disposed proximal links 372 that are actuated by the robot 370viat actuation joints 371. These proximal links 372 are in mechanicalcommunication with corresponding joints 374 that are in turn supportingor otherwise positioning support arms 376. In these implementations, thesupport arms are in mechanical and/or operational communication with thesurgical robot 10 by way of a support joint 378, such that the movementof the actuation joints 371 is sufficient to urge the support jointlaterally, rotationally and/or vertically so as to urge the robot 10into various additional positions.

FIG. 47 depicts a further alternative embodiment using a ball-like joint380 supported by a support bar 382 to provide adequate degrees offreedom to the robot 10 near the insertion point 318. In thisimplementation, the ball-like joint can be used to adjust the threerotations and one translation (in/out) of the robot 10, as would beunderstood by one of skill. It is further understood that in certainimplementations, a lever lock could be used to unclamp the ball andallow all four degrees of freedom to move.

As shown in FIGS. 48A-48D-2 , in further alternate implementations, a“hangman” support structure 400 is used to support the robot 10. In thisimplementation, a curved, pivoting support staff 402 is attached to theoperating room table 303 and extends above the patient cavity 316. Inthis implementation, the support staff 404 is in operationalcommunication with a suspended, articulating “J-hook” 404 that extendsover the patient. In this implementation, the J-hook has an additionaltelescoping link 406 withball joints 408, 410 at either end and is usedto support and position the robot 10. In various implementations, and asshown in FIGS. 48B-1 through 48D-2 , rotational movement of the supportstaff causes corresponding movement of the J-hook 404 and associatedlink 406 and joints 408, 410 so as to “swing” the hangman 400 and, inturn, the device 10 about a central position 318. It is understood thatmany alternate constructions are possible.

FIG. 49 shows a further alternate implementation showing a rotatingsupport (also referred to as a “Lazy Susan support”) 420 for the robot.In these implementations, the robot (not shown) is supported by asupport arm 422 (similar to FIG. 37 , for example) that allows forpositioning or adjustment of the support 420 in relation to theinsertion point 424 in the patient. That is, a support ring 425 iscoupled to a distal end of the support arm 422 and can be positionedadjacent to or on the insertion point 424 of the patient. As isunderstood in the art, the insertion point 424 can be an incision or anatural orifice in the patient. The support 420 has a “yaw” degree offreedom in the form of a rotational ring 426 that is rotatable inrelation to the support ring 425 around the insertion point 424.Further, the support 420 has a “pitch” degree of freedom by way of thecross-links 428 that are rotatable around an axis that is transverse tothe axis of the rotatable ring 426. Coupling plates 430 are rotatablyattached to the cross-links 428 and are configured to couple to thesides of a robotic device (such as, for example, device 10). Accordingto one implementation, the coupling plates 430 can be any couplingcomponents capable of coupling to a robotic device. The robot (notshown) can be inserted at different depths using the plates 430, whichare attached to the cross-links 428 with a passive joint that allows forerrors in acting about the insertion point 424 introduced by variationsin the abdominal wall thickness. More specifically, each of thecross-links 428 are rotatably coupled at one end to the rotational ring426 and rotatably coupled at the other end to the plates 430, therebymaking it possible for the robot (such as robot 10) to be moveable so asto address any unknown abdominal wall thickness. In one embodiment, thecross-links 428 can be any elongate members that can be rotatablycoupled to the rotational ring 426 and the coupling plates 430.

An alternate rotating support 440 implementation for a device (such asdevice 10) is shown in FIGS. 50A-D. Here, a support ring 444 supportedby two support arms 448 and an open arc pitch track (also referred toherein as a “pitch frame”) 446 moveably coupled to the ring 444 providesboth yaw (y) and pitch (p) degrees of freedom as shown in FIG. 50A. Morespecifically, the pitch track 446 has a coupling component 447 that isslidably coupled to the support ring 444 such that the pitch track 446can slide along the ring 444 to different positions around the ring 444as best shown in FIGS. 50B-50D, thereby providing the yaw (y) degree offreedom for the device 10 in which the device 10 can be rotated aroundas shown. It is understood that the coupling component 447 can be anymechanism or device that can be slidably coupled to the support ring 444to allow the pitch track 446 to coupleably slide along the ring 444 asdescribed herein.

The pitch frame 446 can be slidably positioned on the ring 444 andselectively locked into the desired position or location on the ring444. Further, a carriage 452 is provided that is slidably coupled to thepitch track 446 and which receives the robotic device 10. That is, therobotic device 10 can be slidably coupled to the carriage 452. Thecarriage 452 can slide along the pitch track 446 in the directionindicated by reference letter p and can be selectively locked into thedesired position or location on the track 446, thereby providing thepitch degree of freedom for the device 10 when coupled thereto. Further,because the device 10 is coupled to the carriage 452 such that it can beslidably positioned in the carriage 452 and selectively locked into thedesired position in the carriage, the carriage 452 provides thetranslational degree of freedom for the device 10. The pitch track 446,according to one embodiment, can be any mechanism or device to which thecarriage 452 or the robotic device 10 can be slidably coupled so as toprovide the pitch degree of freedom. In this implementation, the pitchtrack 446 has a first arm 446A and a second arm 446B that are positionedto define a track space 449 therebetween such that the carriage 452 canbe slidably coupled to the first and second arms 446A, 446B and slidealong the track space 449. In various embodiments, the two arms 446A,446B are curved in an arc as shown to provide for the pitch degree offreedom such that the carriage 452 moves along the arc and therebytransfers the pitch degree of freedom to the device 10.

In certain alternative embodiments, the ring 44 can be supported by onesupport arm or three or more support arms. In this implementation, thetwo support arms 448 are positioned to align the ring 444 with theinsertion point 450 (which can, as with other embodiments, be anincision or a natural orifice).

Another implementation of a robotic device support 460 can be seen inFIG. 51 . In this embodiment, the device support 460 has two frames: afirst frame (“first track,” “pitch frame,” or “pitch track”) 462 and asecond frame (“second track,” “roll frame,” or “roll track”) 464. Thefirst track 462 is made up of two arms 462A, 462B that are positioned todefine a track space 463 therebetween such that the second track 464 canbe moveably coupled to the first and second arms 462A, 462B and movealong the track space 463. In various embodiments, the two arms 462A,462B are curved in an arc as shown such that the second track 464 movesalong the arc. In this implementation, each of the two arms 462A, 462Bhas a gear track 465A, 465B coupled to the arms 462A, 462B as shown suchthat the second track 464 can couple at each end to the gear tracks465A, 465B and thereby move along the two arms 462A, 462B.

The second track 464 is made up of two arms 464A, 464B that arepositioned to define a track space 467 therebetween such that a carriage466 can be moveably coupled to the first and second arms 464A, 464B andmove along the track space 467. In various embodiments, the two arms464A, 464B are curved in an arc as shown such that the carriage 466moves along the arc. In this implementation, each of the two arms 464A,464B has a gear track 469A, 469B coupled to the arms 464A, 464B as shownsuch that the carriage 466 can couple to the gear tracks 469A, 469B andthereby move along the two arms 464A, 464B. The two arms 464A, 464B havecoupling components 468A, 468B at each end thereof that are configuredto couple to the arms 462A, 462B (and related gear tracks 465A, 465B) ofthe first frame 462. More specifically, in this embodiment, the couplingcomponents 468A, 468B have motors and gears (not shown) that allow forthe coupling components 468A, 468B to move along the gear tracks 465A,465B. That is, the gears (not shown) in the coupling components 468A,468B are coupled to the gear tracks 465A, 465B respectively and themotors (not shown) can actuate those gears to turn in the appropriatedirection to cause the second track 464 to move along the two arms 462A,462B of the first track 462.

The carriage 466 is configured to receive the robotic device 10 in afashion similar to the carriage 452 discussed above with respect toFIGS. 50A-50D. That is, the carriage 466 is moveably coupled to thesecond track 464 and receives the robotic device 10 such that therobotic device 10 can be slidably coupled to the carriage 466. Thecarriage 466 in this embodiment has motors and gears (not shown) thatallow for the carriage 466 to move along the gear tracks 469A, 469B ofthe second track 464 in a fashion similar to the coupling components468A, 468B described above. Alternatively, the first and second tracks462, 464 can each be any mechanism or device to which the second track464 or carriage 466 can be slidably coupled.

According to one implementation, the two frames 462, 464 can provide forthree degrees of freedom. That is, the second frame 464 can move alongthe first track space 463 via the coupling components 468A, 468B movingalong the first and second arms 462A, 462B, thereby providing the pitchdegree of freedom for the device 10 as represented by the arrow P.Further, the carriage 466 can move along the second track space 467 bymoving along the first and second arms 464A, 464B, thereby providing theroll degree of freedom for the device 10 as represented by the arrow R.In addition, the device 10 is slideably positioned in the carriage 466such that it can moved translationally toward and away from the surgicalspace, thereby providing the translational degree of freedom for thedevice 10. It is also understood that a fourth degree of freedom can beprovided by coupling this support 460 to a rotatable support ring (suchas the ring 444 discussed above) to achieve a yaw degree of freedom,thereby providing for positioning the robot 10 in three degrees offreedom (pitch, roll, and yaw as described herein) around a center ofrotation 470, along with the translational degree of freedom.

FIG. 52 depicts another support embodiment 500 having a track 502 alongwhich the robotic device 10 can move in a similar fashion to thecarriage embodiments discussed above. It is understood that the track502 can have any of the features described above with respect to othertrack embodiments. A handle 504 is coupled to one end of the track 502and can slide the track 502 translationally or rotate the track 502.More specifically, the handle 504 has an inner component 504B and anouter component 504A that is slideable in relation to the innercomponent 504B. Further, the handle 504 is coupled to the track 502 suchthat when the outer component 504A is slid in relation to the innercomponent 504B, the outer component 504A moves the track 502 in the sametranslational direction as indicated by arrow T. For example, when theouter component 504A is urged distally toward the surgical space(represented by the sphere S), the track 502 is also urged toward thesurgical space in the direction reflected by arrow T, and when the outercomponent 504A is urged away, the track 502 is also urged away. Inaddition, the entire handle 504 can also be rotated around its ownlongitudinal axis, thereby urging the track 502 to rotate in the samedirection as arrow P, thereby resulting in the pitch degree of freedom.Further, the device 10 can be slidably or otherwise moveably coupled tothe track 502 such that it can be urged translationally toward or awayfrom the surgical space and can be rotated around its own longitudinalaxis.

A further support embodiment 520 is depicted in FIG. 52B. In thisembodiment, the support 520 has two tracks 522, 524 that are coupled or“in parallel.” That is, the support 520 has a single carriage 526 thatis coupled to both the first and second tracks 522, 524, therebyresulting in coupled movement of the carriage 526 in relation to the twotracks 522, 524. It is understood that the two tracks 522, 524 can bestructured in a similar fashion to and have similar features to theprevious track embodiments discussed above. Further, the carriage 526can be similar to the previously described carriage embodiments, exceptwith respect to the fact that the instant carriage 526 is directlycoupled to both of the tracks 522, 524 as depicted. That is, in thisimplementation, the carriage 526 has two portions (or segments): a topor first portion 526A that is moveably coupled to the second track 524and a bottom or second portion 526B that is moveably coupled to thefirst track 522.

When the carriage 526 slides along the first track 522, the second track524 and the robot 10 rotate as reflected in arrow A. When the carriage526 slides along the second track 524, the first track 522 and the robot10 rotate as reflected in arrow B. Further, as in other carriageembodiments discussed above, the carriage 526 receives the roboticdevice 10 such that the robotic device 10 can be slidably coupled to thecarriage 526, thereby providing the translational degree of freedom forthe device 10. In addition, according to certain embodiments, the twotracks 522, 524 can be coupled to a rotational support ring 528 suchthat both the tracks 522, 524 (along with the carriage 526 and device10) can rotate with the ring 528 or in relation to the ring 528 in afashion similar to the rotational ring embodiments discussed above.

FIG. 52C depicts a further implementation of a support 540. In thisimplementation, the support 540 has a single track 542 that is rotatablypositioned on a ring support 544. A carriage 546 is moveably coupled tothe track 542. It is understood that the track 542 can be structured ina similar fashion to and have similar features to the previous trackembodiments discussed above. Further, the carriage 546 can be similar tothe previously described carriage embodiments.

When the carriage 546 slides along the track 542, the robot 10 rotatesas reflected by arrow A. When the track 542 is rotated in relation tothe support ring 544 (or, alternatively, the ring 544 is rotated), thecarriage 546 and the robot 10 rotate as reflected in arrow B. Further,as in other carriage embodiments discussed above, the carriage 546receives the robotic device 10 such that the robotic device 10 can beslidably coupled to the carriage 546, thereby providing thetranslational degree of freedom for the device 10.

Another embodiment of a robotic device support 560 can be seen in FIG.52D. In this embodiment, the device support 560 has two frames: a firstframe or track 562 and a second frame or track 564. The two frames 562,564 are coupled to each other in a fashion similar to the frames 462,464 in the support 460 discussed in detail above. That is, the secondtrack 564 can be moveably coupled to and move along the first track 562.Either or both of the tracks 562, 564 can have gear tracks as describedabove. Alternatively, the tracks 562, 564 can have any configurationdisclosed or contemplated herein with respect to tracks. In certainimplementations, the second track 564 has coupling components (notshown) at each end that are configured to moveably couple to the firstframe 562. Alternatively, the second track 546 can be moveably coupledto the first track 562 in any fashion.

According to one embodiment, the device 10 can be coupled to the support560 via a carriage (not shown), which can be configured according to anycarriage embodiment disclosed or contemplated herein. Alternatively, thedevice 10 can be coupled directly to the track 564 such that the device10 can be movably coupled to the track 564. As such, the device 10 canmove along the track 564 as reflected by arrow A, can move toward oraway from the surgical space, resulting in the translational degree offreedom as reflected by arrow T, and can rotate around its ownlongitudinal axis as reflected by arrow R. In addition, the second track564 can move along the first track 562, as reflected by arrow B. It isalso understood that a further degree of freedom can be provided bycoupling this support 560 to a rotatable support ring (such as any ofthe support ring embodiments discussed above).

FIG. 52E depicts another embodiment of a support 580. In thisimplementation, the support 580 utilizes ball joints. That is, thesupport has a first or upper ring 582 and a second or lower ring 584that are coupled by three arms 586A, 586B, 586C. Each of the three arms586A, 586B, 586C has ball joints 588 at each end, such that the threearms 586A, 586B, 586C are coupled at one end to the first ring 582 viaball joints 588 and at the other end to the second ring 584 via balljoints 588. The robot 10 is coupled to the second ring 584 as shown. Inone embodiment, the robot 10 is slidably coupled to the second ring 584in a fashion similar to the carriage embodiments above such that therobot 10 can be slid toward or away from the surgical space, therebyresulting in a translational degree of freedom.

It is understood that the configuration of the three arms 586A-C coupledto the two rings 582, 584 via ball joints can result in a single centerof rotation for the robotic device 10 at some point below the secondring 584. As such, if the support 580 is positioned above a patient, thecenter of rotation can be aligned with the surgical insertion point(such as an incision) in a fashion similar to above support embodiments.

A further implementation of a robotic device support 600 is shown inFIG. 52F. In this embodiment, the device support 600 has two frames: afirst frame or track 602 and a second frame or track 604. The two frames602, 604 are coupled to each other in a fashion similar to the frames462, 464 in the support 460 or the frames 562, 564 in the support 560,both of which are discussed in detail above. That is, the second track604 can be moveably coupled to and move along the first track 602. Acarriage 606 is moveably coupled to move along the second track 604.Either or both of the tracks 602, 604 can have gear tracks as describedabove. Alternatively, the frames 602, 604 can have any configurationdisclosed or contemplated herein with respect to frames. In certainimplementations, the second track 604 has coupling components 608A, 608Bat each end that are configured to moveably couple to the first frame602. Alternatively, the second track 604 can be moveably coupled to thefirst track 602 in any fashion.

The carriage 606 (and thus the device 10) can move along the secondframe 604 as reflected by arrow A, can move toward or away from thesurgical space in relation to the carriage 606, resulting in thetranslational degree of freedom as reflected by arrow T, and can rotatearound its own longitudinal axis as reflected by arrow R. In addition,the second track 604 can move along the first track 602, as reflected byarrow B. It is also understood that a further degree of freedom can beprovided by coupling this support 600 to a rotatable support ring (suchas any of the support ring embodiments discussed above).

One control console 720 implementation is shown in FIG. 53 , with a maindisplay 722 that shows the view from the robot camera (such as roboticdevice 10). A secondary touch screen 724 below the main display is usedto interface with various functions of the robot, camera, and system.Two haptic hand controllers 726, 728 are used as user input devices inthis embodiment. These haptic hand controllers 726, 728 are capable ofmeasuring the motion of the surgeon's hands as applied at thecontrollers 726, 728 and applying forces and torques to those hands soas to indicate various information to the surgeon through this hapticfeedback. The console 720 also has pedals 730 to control variousfunctions of the robot. The height of the surgeon console 720 can bevaried to allow the surgeon to sit or stand. Further discussion of theoperation of the haptic feedback can be found in relation to U.S. patentapplication Ser. No. 15/227,813 and the other applications incorporatedby reference herein.

FIG. 54 shows various interoperability and wiring possibilities for thesystem 1. Many concepts are possible, but three exemplary embodimentsare given here in the context of FIG. 54 . In one wiring implementation,the surgeon console 720 (or any other console disclosed or contemplatedherein) interfaces with the electrosurgical generator 740. Then a“monster cable” 742 connects the surgeon console 720 to a breakoutconnector 744 near the surgical environment. The camera 746 and robot 10are then connected to the breakout connector 744. In this scenario, theenergy of the electrosurgical unit 740 is routed through the surgeonconsole 720 prior to being sent to the robot 10. In this implementation,no return pad is provided.

Alternatively, according to another wiring concept, a return pad 748 isprovided that is coupled to the breakout connector 744 such that themonopolar electrosurgical energy is routed through the breakoutconnector 744, the monster cable 742, and the console 720 beforereturning to the electrosurgical generator 740.

In a further wiring alternative, the return pad 748 is coupled to theelectrosurgical generator 740 such that the energy of theelectrosurgical unit is routed through the surgeon console 720 prior tobeing sent to the robot 10 as a result of the monopolar electrosurgicalenergy being routed directly back to the electrosurgical generator 740.

In other embodiments, the system 1 can have a cabling connectorenclosure or cluster with an interface box positioned at one of severalpossible locations on the system 1. For example, FIG. 55 depicts thesystem 1 with an interface box (also referred to herein as a “pod”) 760hung on the table rail of the surgical table 762. In this embodiment,the system 1 has support electronics and equipment such as cautery,light, and other functions 764 that are coupled to the interface box760. The console 720 is also coupled to the interface box 760. The pod760 simplifies connections of the robot 1 in the surgical area. The pod760 can be sterile, or not sterile and covered with a sterile drape, ornot sterile at all. The function of the pod 760 is to simplify thecabling required in the surgical space and to simplify the connection ofthe robot and camera 1 to the surgeon console 720. The interface box 760can be hung on the surgical table 762 inside or outside the sterilefield. The box 760 in some embodiments has indicators such as lights orscreens (not shown) that inform the user that a proper connection hasbeen made and give other forms of feedback to the user. The pod 760 canalso have an interface in the form of buttons, touchscreens, or otherinterface mechanisms to receive input from the user.

In certain alternative embodiments, the pod 760 can be placed on thefloor next to or at some distance from the surgical table 762.Alternatively, the pod 760 can be hung or connected to other locationsor placed on the floor outside the sterile field.

One use of this can be to mount the pod to the bed rail and then at alater time to bring in the sterile robot and camera. The robot andcamera pigtails can then be handed to a non-sterile person to connect tothe pod. This allows for a clean interface between the sterile andnon-sterile field. The pod end could also be draped so that it couldenter the sterile field and be robot and camera connections can beassembled at a sterile table so it can then be brought fully functionaland sterile to the surgeon at the bedside.

The interface box can also be connected to other support electronics andequipment such as cautery, light, and other functions, and the aninterface box can be designed to be on the floor or another locationoutside the sterile field with support electronics.

Although the disclosure has been described with reference to preferredembodiments, persons skilled in the art will recognize that changes maybe made in form and detail without departing from the spirit and scopeof the disclosed apparatus, systems and methods.

1. A robotic surgical device, comprising: a) an elongate structure; b) afirst shoulder operably coupled to a distal end of the elongatestructure, the first shoulder comprising: i) a first shaft; ii) a firstgear pair wherein rotation of the first shaft drives the first gearpair; and iii) a second gear pair wherein the first gear pair drives thesecond gear pair; c) a second shoulder operably coupled to the distalend of the elongate structure, the second shoulder comprising: i) asecond shaft; ii) a third gear pair wherein rotation of the second shaftdrives the third gear pair; and iii) a fourth gear pair wherein thethird gear pair drives the fourth gear pair; and d) a first robotic armoperably coupled to the first shoulder; and e) a second robotic armoperably coupled to the second shoulder.
 2. The robotic surgical deviceof claim 1, wherein the first and second robotic arms are moveable in aworkspace extending from a front side to a back side of the elongatestructure
 3. The robotic surgical device of claim 2, wherein theworkspace extends 180 degrees from the front side to the back side ofthe elongate structure.
 4. The robotic surgical device of claim 1,further comprising at least one actuator.
 5. The robotic surgical deviceof claim 1, wherein the first and second robotic arms comprise at leastone motor disposed within each of the first and second robotic arms. 6.The robotic surgical device of claim 1, further comprising a cameracomponent disposed through a lumen defined in the elongate structure. 7.The robotic surgical device of claim 6, wherein the camera component isconfigured to be an adjustable height camera.
 8. The robotic surgicaldevice of claim 6, wherein the camera component is constructed andarranged to be capable of pitch and yaw.
 9. The robotic surgical deviceof claim 6, wherein the camera comprises a distal tip configured toorient to a defined workspace.
 10. The robotic surgical device of claim6, wherein the camera component comprises at least one light.
 11. Therobotic surgical device of claim 1, further comprising first and secondend effectors.
 12. A robotic surgical device comprising: a) an elongatestructure; b) a first shoulder operably coupled to a distal end of theelongate structure, the first shoulder comprising: i) a first shaft; ii)a first gear pair wherein rotation of the first shaft drives the firstgear pair; and iii) a second gear pair wherein the first gear pairdrives the second gear pair; c) a second shoulder operably coupled tothe distal end of the elongate structure, the second shouldercomprising: i) a second shaft; ii) a third gear pair wherein rotation ofthe second shaft drives the third gear pair; and iii) a fourth gear pairwherein the third gear pair drives the fourth gear pair; d) a firstrobotic arm operably coupled to the first shoulder; and e) a secondrobotic arm operably coupled to the second shoulder; and f) a cameracomponent disposable through a lumen in the elongate structure.
 13. Therobotic surgical device of claim 12, wherein the first and secondshoulders are configured to allow the first and second robotic arms tobe extendable to a front side and a back side of the elongate structure14. The robotic surgical device of claim 12, wherein the first roboticarm further comprises an upper arm and a forearm.
 15. The surgicalrobotic device of claim 12, wherein the first robotic arm furthercomprises at least one first arm actuator disposed within the firstrobotic arm.
 16. The surgical robotic device of claim 12, wherein thesecond robotic arm further comprises at least one second arm actuatordisposed within the second robotic arm.
 17. A robotic surgical system,comprising: a. a robotic surgical device comprising: i. an elongate bodycomprising a lumen defined within the body; ii. a first shoulderoperably coupled to the elongate body, the first shoulder comprising:(A) a first shaft; (B) a first gear pair, wherein rotation of the firstshaft drives the first gear pair; and (C) a second gear pair, whereinthe first gear pair drives the second gear pair; iii. a second shoulderoperably coupled to the elongate body, the second shoulder comprising:(A) a second shaft; (B) a third gear pair, wherein rotation of thesecond shaft drives the third gear pair; and (C) a fourth gear pair,wherein the third gear pair drives the fourth gear pair; iv. a firstrobotic arm operably coupled to the first shoulder; and v. a secondrobotic arm operably coupled to the second shoulder; and b. a cameracomponent removably disposable through the lumen, the camera componentcomprising: (A) a rigid section; (B) an optical section; and (C) aflexible section operably coupling the optical section to the rigidsection.
 18. The surgical robotic system of claim 17, wherein therobotic surgical device further comprises a robotic arm workspaceextending from a front side to a back side of the elongate body.
 19. Thesurgical robotic system of claim 17, wherein the first and second armscomprise at least one motor disposed in each arm.
 20. The roboticsurgical system of claim 17, further comprising a surgical consoleoperably coupled to the robotic surgical device and the cameracomponent.